Updating: How Red States’ Failures To Accept Medicaid Expansion Are Taking Real Money Out Of Local Coffers

We have followed the Tennessee version of this unfortunate, and largely meaninglessly political intransigence, for at least three years here — so I’ll use it as an example once again. But similar examples likely exist in Mississippi, Arkansas, Florida and Georgia, as well.

The graphic at right depicts the “opportunity costs” of failing to fully-expand Medicaid in Tennessee. Click to enlarge it. At the bottom is a photo of the safety net hospital for the poor in Nashville, where there are also real out-of-pocket actual cash dollar losses occurring, as well. Over the last three years, the local Tennessee coffers have been affirmatively drained of $45 million (and $10 million of that just a week or so ago) in real cash flow, because the hospital system’s “safety net” is in dire need of basic support, and repairs — the lack of which are putting patient lives at risk.

As the below quoted Tennessean piece indicates, much of this emergency funding would not be needed, if fewer of Nashville’s poorest citizens didn’t have to rely solely on the crazy-quilt lottery of winning access to TennCare. That state run program is good for those who are on it, but it leaves hundreds of thousands out — out of eligibility. People who would definitively be eligible for Medicaid expansion funding. 90 per cent of that bill is paid by Uncle Sam. Yet the people of Nashville have diverted an incremental $45 million of cash, to this hospital over the last three years — in band-aid fixes — and thus manifestly have less to spend for schools, and police departments, because of it. That makes no sense. None. From the local op ed, then:

. . . .The $10 million subsidy is in addition to the $35 million Metro budgeted in 2015-16 for the Nashville Hospital Authority, which runs Nashville General.

The request came, in part, after a Joint Commission on Hospital Accreditation report in the fall noted “serious deficiencies” in patient safety, infection control, bed capacity and staffing, according Dr. Joseph Webb, who became CEO of Nashville General in December 2014. . . .

We don’t live in the same world we lived in in 2012, particularly in health care.

In 2012, we anticipated that Medicaid expansion, as part of the Patient Protection and Affordable Care Act, would dramatically change how medical services were delivered to low income residents. With health insurance coverage available to the working poor and others who did not qualify for TennCare and could not afford to pay for medical care, Nashville General would not need the broad subsidies from Metro government.

The legislature has not approved a plan to expand Medicaid in Tennessee, but indigent care is still required for the Nashville’s growing population.

Perhaps we need to spend $35 to $45 million a year to take care of the poor, but it seems like we have not clearly articulated why. This year, Nashville will pay a subsidy of more than $400 for each patient visit to Nashville General. Is there a better way?